Lean healthcare has emerged as a transformative approach to enhance efficiency, reduce waste, and improve patient outcomes in hospital settings. This systematic review aims to identify the key issues and challenges in implementing Lean initiatives in hospitals. Guided by the PRISMA framework, an extensive literature search was conducted across PubMed, Scopus, and Web of Science for literature published between January 2015 and December 2023, ultimately including 15 studies. The review categorises challenges into seven primary themes: resource limitations, organisational resistance, knowledge and training gaps, operational inefficiencies, communication barriers, sustainability concerns, and patient-centric obstacles. Study quality and risk of bias were independently assessed using the Joanna Briggs Institute (JBI) and the Center for Evidence-Based Management (CEBMa) critical appraisal tools. Resource constraints, encompassing financial, infrastructural, and human resource shortages, emerged as the most prominent barrier, reported in 66.7% of studies. Organisational resistance, driven by scepticism, fear of job losses, and insufficient leadership support, was the second most frequent challenge, found in 46.7% of studies. Additionally, gaps in staff knowledge and training regarding Lean principles, alongside workflow inefficiencies, further hindered implementation. Communication and coordination issues, often exacerbated by hierarchical decision-making, and challenges sustaining Lean practices due to high staff turnover and shifting priorities were also highlighted. Balancing Lean’s efficiency goals with the need for personalised patient care posed additional complexities. The findings underscore the necessity for comprehensive strategies to address these barriers. Strong leadership commitment, tailored training programs, and resource optimisation are critical for successful and sustainable Lean implementation. While Lean offers significant potential to enhance hospital operations and patient care, overcoming these multifaceted challenges is essential for realising its full benefits. This review provides actionable insights for policymakers and healthcare administrators, aiming to foster effective, context-sensitive strategies to mitigate barriers and promote Lean healthcare adoption.
Nik Dewi Delina Nik Mohd Kamil, A. S. A. Sazali, Darryl Daring et al.· Discover Health Systems· 0 citations
Autism Spectrum Disorder (ASD) is a developmental condition that affects how individuals communicate, interact socially, and behave. One of the factor that is gaining attention is maternal smoking during pregnancy. Nicotine and other substances in tobacco smoke can cross the placenta and may interfere with fetal brain development. Despite these concerns, research findings on whether smoking during pregnancy increases the risk of ASD have been mixed. This review examines current evidence on the relationship between maternal smoking during pregnancy and the risk of ASD in offspring. It aims to assess the consistency and strength of reported associations, identify key confounding variables and evaluate the methodological quality of included studies. A structured search was carried out using PRISMA guidelines to identify observational studies published between January 1st 2013 and April 30th 2025. The review focused on studies with cohort, case-control, or cross-sectional designs. Study quality were assessed using tools from the Joanna Briggs Institute (JBI). From an initial pool of 6,915 records, 11 studies met the inclusion criteria. Most were conducted in high-income settings, with sample sizes ranging from fewer than 200 to over two million participants. Five studies reported statistically significant links between maternal smoking and ASD or its subtypes, though the observed effects were small. The remaining six studies, including the only one that used serum cotinine to verify smoking status, did not find a significant association. Differences in results appeared to relate to how smoking exposure and ASD were defined and measured, as well as differences between study populations. There is no clear or consistent evidence that maternal smoking during pregnancy is an independent risk factor for ASD. While some research points to a possible connection, results vary and are often limited by how smoking and ASD were assessed. Further research using more objective exposure data, larger and more diverse populations, and detailed subgroup analyses is needed to clarify whether any meaningful association exists.
Umairah binti Norazmanl, Nurhsafinaz binti Abu Bakar, A. R. Ramdzan· Borneo Journal of Medical Sc...· 0 citations
